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NUR 346 > Exam 2: weeks 4 & 5 > Flashcards

Exam 2: weeks 4 & 5 Flashcards

1
Q

What is the priority in mental health emergency care

A

Perform triage and stabilization

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2
Q

What is triage

A

Determines the severity of the problem and the urgency of a response

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3
Q

What is stabilization

A

The resolution of the immediate crisis

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4
Q

What is primary prevention

A

Applies to general public; reduces risk of disease

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5
Q

What is secondary prevention

A

Applies to susceptible population before any symptoms occur; screening and early id of problems

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6
Q

What is tertiary prevention

A

Applies to symptomatic patients; reduce complications or disability

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7
Q

When discharging a patient to outpatient services, what are some things that can affect treatment success

A

Housing stability
income
support system
substance abuse
physical well-being

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8
Q

What are the criteria to being admitted to an inpatient psychiatric unit

A

patients who re…
- suicidal
- homicidal
- extremely disabled and need acute care

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9
Q

What is the clinical pathway

A

The essential steps of caring for patients with specific issues based on evidence-based healthcare techniques

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10
Q

What is milieu

A

The setting in which something occurs

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11
Q

What are the characteristics of a therapeutic milieu

A

A safe environment where patients can work with staff to take control of their own mental health and well-being

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12
Q

What are the different outpatient psychiatric care settings

A

community mental health centers
home care
assertive community treatment (ACT)
intensive outpatient programs (IOP)
partial hospitalization programs (PHP)
telepsychiatry
mobile mental health bus

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13
Q

what are community mental health care centers

A

places where people with limited access to private healthcare can go for help

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14
Q

What is assertive community treatment (ACT)

A

Designed for those who have had frequent hospitalizations for mental health crises

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15
Q

What is mobile mental health

A

An emergency service for those who need stabilization out in the community

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16
Q

What are the six principles of bioethics

A

autonomy: patient rights
beneficence: promote good
nonmaleficence: do no harm
justice: equality of care
fidelity: loyalty
veracity: telling the truth

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17
Q

What is pharmacogenetic testing

A

A DNA test to see which antidepressants are most likely to work
- not FDA approved because of lack of clinical evidence
- aims to decrease trial and error approach
- aims to decrease recovery time between medications
- stigmatization could lead to someone losing job oppurtunities

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18
Q

What does “writ of habeas corpus” mean

A

A formal written order to free a person (from a mental institution)
- a patient who believes they are being held unjustly can petition for this

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19
Q

What are the four different discharge procedures from a mental health organization

A
  • unconditional release
  • conditional release
  • release against medical advice (AMA)
  • assisted outpatient treatment
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20
Q

What is an unconditional release

A

Patient is released from the hospital; can be court ordered or facility ordered

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21
Q

What is a conditional release

A

Patient is released on the condition of attending outpatient treatment for a specified amount of time

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22
Q

What is release against medical advice (AMA)

A

When treatment is beneficial for the patient but they are no longer a threat to themselves or others. There is no reason to hold them involuntarily so legally, the patient can leave when they wish

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23
Q

What is assisted outpatient treatment

A

Patient is released on the condition of a COURT ORDERED outpatient treatment regimen

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24
Q

What are the patients rights

A
  • right to treatment
  • right to refuse treatment
  • right to informed consent
  • right to psychiatric advance directives
  • rights regarding isolation and restraints
  • right to confidentiality
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25
Q

What is informed consent

A

patient must be informed of the risks and benefits and alternatives of any treatment and must consent to the treatment
- must be capable of making decisions
- must be competent enough to make decisions
- implied consent is also included

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26
Q

What are a patients rights when it comes to isolation and restraints

A
  • Must have an order and documentation
  • in an emergency, a nurse may place a patient in restraints or isolation but must obtain an order immediately after
  • orders are never written as PRN or standing orders
  • includes chemical, physical, and seclusion restraints
  • chemical restraints are the least restrictive
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27
Q

What are some exceptions to the rule of confidentiality

A
  • duty to warn and protect third parties
  • duty to report elder and child abuse
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28
Q

What is a tort

A

any wrongful act that results in injury to another

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29
Q

What are the intentional torts that nurses commit

A
  • assault
  • battery
  • false imprisonment
  • invasion of privacy
  • defamation of character (slander/libel)
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30
Q

What are the unintentional torts that nurses commit

A
  • negligence
  • malpractice
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31
Q

What are the five elements needed to prove negligence

A
  1. duty
  2. breach of duty
  3. cause in fact: did the negligence cause the injury
  4. proximate cause: was the injury foreseeable
  5. damages
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32
Q

What is forensic nursing

A

A nurse who works at a court and explains the science of nursing to the judge and jury. The nurse will determine:
- patient competency
- if someone is fit to stand trial
- if they need to be involuntarily committed
- if they were responsible for the crime

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33
Q

What are the symptoms of mood dysregulation disorder

A

Seen in children (usually males)
- constant severe irritability and anger
- temper tantrums out of proportion to the situation

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34
Q

How do we treat mood dysregulation disorder

A
  • medications based on symptoms (antidepressants, stimulants (ADHD), or anti anxiety)
  • cognitive behavioral therapy
  • parental training in facial expression recognition
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35
Q

What is persistent depressive disorder

A

Formerly known as dysthymia
- low level depressive feelings most of the day for most days
- for 2 years for adults
- for 1 year for adolescents

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36
Q

What are the symptoms of persistent depressive disorder

A
  • Decreased appetite or overeating
  • insomnia or hypersomnia
  • low energy
  • poor self-esteem
  • difficulty thinking
  • hopelessness
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37
Q

What is premenstrual dysphoric disorder

A

symptoms that occur the week before a person’s menstrual cycle. Symptoms decrease or disappear at the onset of their period and menopause.

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38
Q

What are the symptoms of premenstrual dysphoric disorder

A
  • Mood swings
  • irritability
  • depression
  • anxiety
  • feeling overwhelmed
  • difficulty concentrating
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39
Q

What is the treatment for premenstrual dysphoric disorder

A

FDA approved
- drospirenone and ethinyl estradiol contraceptives
- SSRIs

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40
Q

What are the symptoms of major depressive disorder

A
  • depressed mood
  • anhedonia (loss of interest or pleasure)
  • appetite changes
  • weight changes
  • sleep disturbances
  • worthlessness/guilt
  • unable to concentrate
  • psychomotor agitation
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41
Q

What are the risk factors for getting major depressive disorder

A
  • genetic (immediate family members)
  • biochemical (stressful life events)
  • hormonal
  • inflammatory (not directly but research suggests it plays a role)
  • cognitive (early life experiences cause irrational thoughts when going through stressful situations later)
  • gender (female)
  • other mental disorders
  • substance abuse
  • chronic medical conditions
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42
Q

What is the mnemonic used to assess a patient for depression

A

SIG E CAPS
S- sleep disturbance
I- interest decreased
G- guilty feelings
E- energy decreased
C- concentration decreased
A- appetite changes
P- psychomotor function decreased
S- suicidal ideations

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43
Q

What are the three phases of the implementation step of the nursing process for mental health

A
  1. acute phase
  2. continuation phase
  3. maintenance phase
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44
Q

What does the acute phase of implementation include

A

6-12 weeks
- initial treatment
- need 4-6 weeks to see if the treatment is working for them

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45
Q

What does the continuation phase of implementation include

A

4-9 months
- continue treatment
- monitor for signs of relapse
- monitor for side effects

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46
Q

What does the maintenance phase of implementation include

A

1 year +
- continue treatment
- monitor for signs of relapse

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47
Q

Which class of medications are most commonly prescribed for major depressive disorder

A

SSRIs

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48
Q

What are some examples of SSRIs

A
  • citalopram(Celexa)
  • escitalopram(Lexapro)
  • fluoxetine (Prozac)
  • paroxetine (Paxil)
  • sertraline (Zoloft)
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49
Q

Why are SSRIs the first-line treatment for major depressive disorder

A
  • low instance of anticholinergic side effects
  • low cardiotoxicity
  • fast onset (compared to other classes)
  • patient compliance is better
  • also good for anxiety and dysphoria
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50
Q

What are the side effects of SSRIs

A
  • agitation
  • sleep disturbance
  • tremor
  • anorgasmia
  • headache
  • dry mouth
  • sweating
  • weight change
  • mild nausea
  • loose bowel movements
  • central serotonin syndrome (CSS)
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51
Q

What are the symptoms of serotonin syndrome

A
  • abdominal pain
  • diarrhea
  • sweating
  • fever
  • tachycardia
  • elevated BP
  • delirium
  • myoclonus (incoordination/ rigidity)
  • irritability
  • hyperpyrexia (extremely high fever > 41 C (105.8 F)
  • cardiovascular shock
52
Q

What are some SNRI drugs

A
  • Duloxetine (Cymbalta)
  • Venlafaxine (Effexor)
  • desvenlafaxine (Pristiq)
  • levomilnacipran (Fetzima)
53
Q

What is the difference between an SSRI and an SNRI

A
  • same side effects
  • Serotonin reuptake inhibition vs. serotonin and norepinephrine reuptake inhibition
  • SSRIs are tolerated better
54
Q

How do tricyclic antidepressants work

A

Block the reuptake of serotonin and norepinephrine at the presynaptic neuron
- takes 10-14 days to work
- therapy continued 6-12 months to prevent relapse
- starts at a low dose then increases

55
Q

What are the side effects of tricyclic antidepressants

A
  • anticholinergic effects
  • cardiac dysrhythmias
  • tachycardia
  • myocardial infarction
  • heart block
56
Q

What are anticholinergic effects

A
  • dry mouth
  • blurred vision
  • tachycardia
  • orthostatic hypotension
  • constipation
  • urinary retention
  • esophageal reflux
57
Q

When taking tricyclic antidepressants, what other drugs should you avoid

A
  • MAOIs
  • phenothiazines
  • barbiturates
  • disulfiram
  • oral contraceptives
  • anticoagulants
  • benzodiazepines
  • alcohol
  • nicotine
  • some antihypertensives
58
Q

When would someone be prescribed an MAOI

A
  • unconventional depression
  • anxiety disorders
59
Q

What things should be avoided when taking MAOIs

A

foods containing tyramine, tryptophan, and foods that affect dopamine

60
Q

What are some MAOI drugs

A
  • Isocarboxazid (Marplan)
  • Phenelzine (Nardil)
  • Selegiline
  • Tranylcypromine
61
Q

What are the side effects of MAOIs

A
  • orthostatic hypotension
  • weight gain
  • edema
  • change in heart rate and rhythm
  • constipation
  • urinary hesitancy
  • vertigo
  • hypomanic or manic behavior
  • insomnia
  • weakness
  • fatigue
62
Q

What are the classes of drugs used to treat major depressive disorder

A
  • SSRIs
  • SNRIs
  • TCAs
  • MAOIs
  • SARIs
  • NDRIs
  • NaSSA
63
Q

What are the two newest drugs used for major depressive disorder

A

Esketamine: NMDA antagonist
Brexanolone (Zulresso): only FDA approved drug for post-partum depression

64
Q

What are some non-pharmacological treatments for major depressive disorder

A
  • Electroconvulsive therapy (ECT)
  • Repetitive Transcranial magnetic stimulation
  • Vagus nerve stimulation
  • Deep brain stimulation
  • Light therapy
  • St. John’s wort
  • Exercise
65
Q

What is electroconvulsive therapy

A
  • sends electricity through the brain causing a seizure
  • used when other methods are not working
  • side effects include confusion, disorientation, and short-term memory loss
66
Q

What is repetitive transcranial magnetic stimulation

A
  • use MRI strength magnets to stimulate the cerebral cortex
  • non-invasive
  • metal in head is a contraindication
  • side effects include headache, lightheadedness, scalp tingling/discomfort, seizure (rarely)
67
Q

What is vagus nerve stimulation

A
  • originally used to treat epilepsy
  • electrical stimulation to decrease seizures and boost mood by increasing neurotransmitter levels
  • side effects include Voice alteration, Neck pain, cough, paresthesia, and dyspnea
68
Q

What is deep brain stimulation

A
  • surgically implanted electrodes in the brain
  • stimulates regions seen to be underactive in depression
  • FDA approved for parkinson’s and OCD but off label for MDD
69
Q

What is light therapy

A
  • first line treatment for seasonal affective disorder
  • special light is pointed at persons face for 30 minutes each day
  • negative effects are headache and jitteriness
70
Q

What is St. John’s wort

A
  • herbal supplement said to help depression
  • not FDA approved
  • dosing variable
  • interacts with lots of other drugs
71
Q

What are the different levels of anxiety

A
  • mild anxiety
  • moderate anxiety
  • severe anxiety
  • panic
72
Q

What are the characteristics of mild anxiety

A
  • everyday problem solving
  • grasp information effectively
  • slight discomfort: fidgeting, nail-biting
73
Q

What are the characteristics of moderate anxiety

A
  • selective inattention
  • clear thinking impaired
  • poor problem solving
  • sympathetic nervous system symptoms such as tension, pounding heart, increased pulse and respiration rate, diaphoresis,
74
Q

What are the characteristics of severe anxiety

A
  • inattention greatly increased
  • difficulty concentrating on environment
  • confused, automatic behavior
  • problem solving not possible
  • sympathetic symptoms increase
  • sense of doom
75
Q

What are the characteristics of panic

A
  • disturbed behavior (running, screaming, pacing)
  • loss of touch with reality
  • impulsive behaviors
76
Q

What are defense mechanisms

A

Automatic psychological processes that protect a person from anxiety and awareness of internal or external dangers

77
Q

What are the 6 defense mechanisms

A
  • repression
  • denial
  • projection
  • displacement
  • regression
  • sublimation
78
Q

What is repression

A

unconscious exclusion of unpleasant experiences

79
Q

What is denial

A

ignoring things that cause you anxiety

80
Q

What is projection

A

Putting unwanted thoughts about yourself on others (a cheating person accuses their spouse of cheating)

81
Q

What is displacement

A

Taking stressors out on non-threatening person (boss yells at you at work so you go home and kick your dog)

82
Q

What is regression

A

Reverting to childlike behavior when stressed (sucking your thumb)

83
Q

What is sublimation

A

transforming negative impulses to positive actions (angry at dad, punches punching bag instead of him) (person wants to inflict pain on people, becomes a dentist)

84
Q

What is separation anxiety disorder

A
  • inappropriate level of concern when separated from a significant other
  • fear that something terrible will happen
  • typically diagnosed prior to age 18
85
Q

What are the most common phobias

A
  • dogs
  • spiders
  • heights
  • storms
  • water
  • closed spaces
    (tends to run in the family)
86
Q

What are the most common phobias

A
  • dogs
  • spiders
  • heights
  • storms
  • water
  • closed spaces
    (tends to run in the family)
87
Q

What is social anxiety disorder

A

severe anxiety caused by a social or performative expectation that will be looked at negatively by others

88
Q

What is social anxiety disorder

A

severe anxiety caused by a social or performative expectation that will be looked at negatively by others

89
Q

What is panic disorder

A

recurrent, sudden, unexpected panic attacks
symptoms include:
- terror
- limited perceptual field
- severe personality disorganization

90
Q

What is agoraphobia

A

Fear of being in an environment or situation where escape is difficult
(e.g., being alone outside; being home alone; traveling in a car, bus, or plane; being on a bridge or in an elevator).

91
Q

What is generalized anxiety disorder

A

Excessive worry that lasts for months
- out of proportion of what’s happening
- constantly anticipate disaster
- females 2X more than males

92
Q

What are some symptoms of generalized anxiety disorder

A
  • sleep disturbances
  • irritability
  • tense muscles
93
Q

What is substance-induced anxiety disorder

A

Anxiety brought on by use of a substance or within a month of stopping use of a substance.
(alcohol, heroin, cocaine, hallucinogens)

94
Q

What are some things that cause anxiety

A
  • genetics
  • depression
  • other medical conditions
95
Q

What are somatic symptoms of anxiety

A
  • sensation of choking
  • feeling smothered
  • numbness/tingling
96
Q

What are some cognitive symptoms of anxiety

A
  • fear of dying
  • offensive body processes
  • fear of witchcraft (cultural)
  • fear of magic (cultural)
97
Q

What is an obsession

A

Thought, impulses, or images in the mind that won’t go away

98
Q

What is a compulsion

A

ritualistic behaviors that are done in order to reduce anxiety or to stop something bad from happening

99
Q

What are the different types of obsessive compulsive disorders

A
  • body dysmorphic disorder
  • hoarding disorder
  • Trichotillomania
  • Excoriation disorder
  • Substance-induced obsessive-compulsive and related disorders
  • Obsessive-compulsive or related disorder due to a medical condition
100
Q

What is body dysmorphic disorder

A

A preoccupation with an imagined or defective body part
- mirror checking
- camouflaging
- overwhelming feelings of disgust
- fear of rejection by others
- usually involves weight, facial features, stomach, breasts/chest

101
Q

What is hoarding disorder

A

Obsessively accumulating things that may or may not be valuable to the person.
- usually have depression, social phobia, GAD, and/or ADHD
- letting go of any object is painful
- collecting consumes their life
- person is alienated

102
Q

What is Trichotillomania

A

Obsessive hair pulling

103
Q

What is excoriation disorder

A

Obsessive skin-picking

104
Q

What are some risk factors for OCD

A
  • child abuse
  • trauma
  • post-infectious autoimmune syndrome
  • genetics
  • anxiety disorders
  • eating disorders
  • tic disorders
105
Q

What is post-infectious autoimmune syndrome

A

An infection causes an autoimmune response that attacks the brain which causes encephalopathy and affects thoughts and behaviors

106
Q

What classes of drugs are prescribed for anxiety disorders

A
  • SSRIs: first choice
  • SNRIs: also very helpful
  • TCA: clomipramine
  • MAOIs: only for resistive disorders (not usual)
  • Benzodiazepines: addictive, short term
  • BuSpar: not addictive but takes 2-4 weeks to work
  • other: beta-blockers, antihistamines, anticonvulsants (according to other health issues)
107
Q

Which drugs are commonly prescribed to children with OCD

A
  • fluoxetine (SSRI)
  • fluvoxamine (SSRI)
  • sertraline (SSRI)
  • clomipramine (TCA)
108
Q

What are some brain-based therapies for OCD

A

Gamma knife: creates lesions to form a disconnect of overactive pathways
Deep brain stimulation: implanted electrodes use electricity to reduce symptoms

109
Q

What is the goal of cognitive behavioral therapy in treating OCD

A
  • exposure to triggers
  • show that anxiety does resolve even when ritual is not completed
110
Q

What is the flooding technique

A

Exposing someone with OCD to large amounts of their triggers in order to extinguish the response

111
Q

What are some risk factors for suicide

A
  • depressive disorders
  • schizophrenia
  • alcoholism
  • substance abuse
  • borderline personality disorder
  • antisocial personality disorder
  • panic disorder
  • male gender
  • genetics
  • aging
  • physical health issues
112
Q

Why are adolescents at a higher risk of commiting suicide

A

Immature prefrontal cortex; controls executive functions such as:
- judgement
- frustration tolerance
- impulse control

113
Q

What are you looking for when you assess for risk of suicide

A
  • verbal clues
  • nonverbal clues
  • lethality of the plan
  • history of attempts
  • family history
  • sudden switch from sad to happy mood
  • social supports
114
Q

What are overt statements

A

Statements about death and dying
“life just isn’t worth living anymore”

115
Q

What are covert statements

A

Statements that aren’t directly about death or dying but are still ominous
“I won’t be a problem much longer”
“how do I donate my body to science”
“things will never work out”

116
Q

What are some behaviors to look put for when assessing a patient for suicide

A
  • giving away prized possessions
  • withdrawing
  • making final arrangements
  • sudden unexplained recovery from hopelessness
117
Q

What scale is used to assess for suicide

A

SAD PERSONS
S - sex (male)
A - age (25-44 or 65+)
D - depression
P - previous attempt
E - ethanol use
R - rational thinking loss
S - social support (lacking or loss)
O - organized plan
N - no spouse
S - sickness

118
Q

What are some “hard” methods of suicide

A

Kill the person fast
- firearms
- jumping off a high place
- hanging
- carbon monoxide
- car crash

119
Q

What are some “soft” methods of suicide

A

kill the person slowly
- slitting wrists
- taking pills

120
Q

When determining the lethality of someone’s suicide plan, what things are you going to ask about

A
  • Is there a specific plan with details (more details means higher risk)
  • how lethal is the method (hard or soft)
  • are the mean available to the person (do they have a gun, pills, a place to jump etc.)
121
Q

What are the different levels of intervention for a patient who is suicidal

A
  • primary
  • secondary
  • tertiary
122
Q

What is primary intervention for suicide

A

activities that provide support and education to prevent serious situations

123
Q

What is secondary intervention for suicide

A

treatment of a suicidal crisis. Use patients indecision to lead them towards not commiting suicide

124
Q

What is tertiary intervention for suicide

A

Helping the families and loved ones of those who have committed suicide deal with the traumatic aftermath
Or help a person who had a failed attempt at suicide deal with the repercussions of their actions

125
Q

What are some precautions taken for the psychiatric unit to prevent suicide

A
  • use (and count) plastic utensils
  • no private rooms
  • keep room doors open
  • jump-proof and hang-proof bathrooms
  • remove harmful possessions
126
Q

What are some non-suicidal self-injury behaviors

A
  • cutting
  • burning
  • scratching
  • biting
  • hitting
  • skin picking
  • interference with wound healing

NUR 346 (7 decks)

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